TX HHS Form 3076. Case Record Information Release

The TX HHS Form 3076, "Case Record Information Release," is a crucial document that facilitates the sharing of information related to an individual's case record. This form enables individuals to authorize the release of their personal and medical information to various entities, such as healthcare providers or government agencies.

This form is particularly useful in situations where an individual needs to access or share their health records with a third party, such as when applying for assistance through the County Indigent Health Care Program (CIHCP). The form requires the applicant's signature and specifies the type of information that can be released, including the period covered. It also allows for a general release of all available information.

The key features of this form include the required information section, which includes the case record name and number, as well as the specific request and period covered sections. The form is valid for six months after the date signed, and it must be completed by the applicant or their authorized representative, such as a spouse, guardian, or parent.